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Information Collection

Medicare Advantage Applications - Part C (CY 2010)

IC 8785 under ICR 200906-0938-003 · OMB 0938-0935.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Medicare Advantage Applications - Part C (CY 2010)
 
No Modified
 
Mandatory
 
42 CFR 422.501 42 CFR 422.503 42 CFR 422.504 42 CFR 422.506 42 CFR 422.508 42 CFR 422.510 42 CFR 422.512 42 CFR 422.516 42 CFR 422.500 42 CFR 422.502 42 CFR 422.505 42 CFR 422.514 42 CFR 422.520 42 CFR 422.521 42 CFR 422.524 42 CFR 422.527

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10237 Part-C Medicare Advantage Application CMS10237-PartC-MA-APP-CLEANVERSION-12-4-08.doc Yes Yes Paper Only
Form and Instruction CMS-10214 Medicare Advantage/Prescription Drug Benefit CMS-10214 2009 EGWP MAO Applicationfinal1125(cleanversion).doc Yes Yes Paper Only

Health Health Care Services

 

267 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 267 0 0 0 0 267
Annual IC Time Burden (Hours) 6,490 0 0 0 0 6,490
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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